Breast Anatomy

2-Phase Expression

Babies intuition transformed into technological know-how more

2-Phase Expression

Double Pumping

The benefits of Double Pumping compared to single pumping, are well known, but the latest scientific research has not only confirmed this, but has also uncovered further benefits for pumping mothers. more

Double Pumping

Evidence Based Research

We work with experienced medical professionals and seek collaboration with universities, hospitals and research institutions worldwide. more

Infant Sucking

See how the baby feeds at the breast more

Anatomy of the Lactating Breast old view
Anatomy of the Lactating Breast old view

Anatomy of the Lactating Breast

Ultrasound imaging has improved greatly over the last 10 years and this has enabled the experts to study the anatomy of the lactating breast in closer detail.

For 150 years the images seen in physiology and anatomy books have remained the same.

Whilst studying milk ejection, Dr Donna Geddes from the University of Western Australia, began to question what she was seeing using ultrasound compared to what the text books were showing.

Further research was carried out, supported by Medela, and the results were revolutionary.

Anatomy of women's breast revised knowledge
This image has been created to show the revised knowledge.
Anatomy of women's breast revised knowledge

You can note the ductal network is quite radial, it branches quite far into the breast and there are 'reservoirs' or 'lactiferous sinuses' close to the nipple. Although not seen, it was also thought that there were between 15 and 20 ducts and there was equal amount of glandular to fatty tissue.

The research carried out at the University of Western Australia, highlighted 4 main differences:

  • Ducts branch closer to the nipple
  • The conventionally described lactiferous sinuses do not exist
  • Glandular tissue is found closer to the nipple
  • Subcutaneous fat is minimal at the base of the nipple
     

We can see the comparison here:

Medela produced an image to demonstrate the new findings and many textbooks and internet sites now use this image as a base.

You can download this and other material for trainings here:

Relevance to Practice

Although the knowledge gained does not necessarily change the way we practice, it does help us to understand, why we do the things we do!

There are 3 main considerations in relation to lactation practice:

1. A rapid fist milk ejection is important for efficient milk removal
2. Breastshields need to be the correct size for an individual mother
3. Hand positioning: when supporting the breast or for manual expression

1. A rapid, efficient first milk ejection is important for optimal milk removal

Large volumes of milk are not stored in the ducts as no lactiferous sinuses were observed, therefore very little milk can be removed prior to milk ejection. It is known that a baby will initially have a rapid sucking action, which stimulates the breast to 'let down', and the research shows that a rapid first milk ejection will then lead to more subsequent milk ejections. In fact, 80% of the breastmilk is removed in the first 7 minutes when using a 2-Phase breastpump at maximum comfort vacuum (Kent et al 2006)
It is therefore important to ensure a good latch to help initiate let down and if pumping, to use a breastpump that can stimulate the milk ejection efficiently.

2. Breastshields need to be the correct size for an individual mother

A correctly fitting breastshield will avoid compression on the superficial milk ducts. It will allow the milk to be transferred from the breast to the container completely and comfortably.
You can assess if you are recommending the correct size here:
 

3. Hand positioning: when supporting the breast or expressing

As 65% of the glandular tissue is situated within the first 30mm from the nipple and the ducts are quite superficial, it is important to consider position of hands and fingers when feeding or pumping. Pressure on the ducts and tissue, can cause milk not to flow freely and this can lead to blockages and in turn to engorgement and then a reduction in milk supply. When milk is not removed from the breast, a protein called Feedback Inhibitor of Lactation (FIL) is produced. When the amount of FIL increases, a signal is sent to the hypothalamus to reduce prolactin and hence milk production is reduced. To avoid this happening, mothers should be advised on how to position the baby so that they do not have to put too much pressure on the breast during a feed or whilst pumping.
 

Further Reading:

Gooding M. J., Finlay J., Shipley J.A., Halliwell M., and Duck F.A. Three-dimensional ultrasound imaging of mammary ducts in lactating women: a feasibility study. Journal of Ultrasound Medicine 29 (1):95-103 (2010)

Kent, J.C., Mitoulas, L.R., Cox, D.B., Owens, R.A. and Hartmann, P.E. Breast volume and milk production during extended lactation in women. Experimental Physiology 84: 435-447 (1999)

Kent, J.C., Ramsay, D.T, Doherty, D., Larsson, M. and Hartmann, P.E. Response of breasts to different stimulation patterns of an electric breast pump. Journal of Human Lactation 19: 179 - 186 (2003)

Mitoulas, L.R., Lai, C.T., Gurrin, L.C., Larsson, M. and Hartmann, P.E. Efficacy of breastmilk expression using an electric breast pump. Journal of Human Lactation 18(4): 344-352 (2002)

Mitoulas, L.R., Lai, C.T., Gurrin, L.C., Larsson, M. and Hartmann, P.E. Effect of vacuum profile on breast milk expression using an electric breast pump. Journal of Human Lactation 18(4): 353-360 (2002)

Ramsay DT, Kent JC, Hartmann RA and Hartmann PE (2005) Anatomy of the lactating human breast redefined with ultrasound imaging. Juornal of anatomy, 206:525-534

Ramsay, D.T., Kent, J.C., Owens, R.A. and Hartmann, P.E. Ultrasound imaging of milk ejection in the breast of lactating women. Pediatrics 113: 361 - 367 (2004)

Ramsay, D.T., Mitoulas, L.R., Kent, J.C., Larsson, M. and Hartmann, P.E. The use of ultrasound to characterize milk ejection in women using an electric breast pump. Journal of Human Lactation 21(4): 421- 428 (2005)

Ramsay, D.T. Mitoulas, L.R., Kent, J.C., Cregan, M.D., Doherty, D.A., Larsson, M. and Hartmann, P.E. Milk flow rates can be used to identify and investigate milk ejection in women expressing breast milk using an electric breast pump. Breastfeeding Medicine 1: 14 - 23 (2006)

Continuing research is paramount to support mothers and babies to continue to breastfeed as long as possible.

Medela group exits to enhance the health of mothers and babies through the life giving benefits of breastmilk and we will continue to do research to provide up to date information for health professionals who support breastfeeding mothers.

Our annual research symposiums ((link to events)) are an opportunity to bring the experts into the field and for you, as a professional to learn directly from them in order to continually improve your practice.